Jail/Custody suicide: A compendium of suicide prevention standards and resources

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Jail/Custody Suicide:

A Compendium of Suicide Prevention Standards and Resources

edited by

Daniel B. Kennedy, Ph.D.

University of Detroit Mercy

and

Richard McKeon, Ph.D., M.P.H.

Clinical Division Director, American Association of Suicidology

for the

Jail Suicide Task Force

American Association of Suicidology

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Introduction ... 1

American Correctional Association ... 5

Adult Local Detention Facilities (Jails) ... 5

Small Jail Facilities (<50) ... 7

Adult Correctional Facilities (Prison) ... 10

Juvenile Training School ... 14

Juvenile Detention Facilities ... 16

National Commission on Correctional Health Care ... 20

Health Services in Jails ... 20

Health Services in Prisons ... 28

Health Services in Juvenile Detention and Confinement Facilities ... 34

Commission on Accreditation for Law Enforcement Agencies... 38

American Jail Association ...41

International Association of Chiefs of Police ... 42

National Sheriff=s Association ...44

American Public Health Association ... 45

American Psychiatric Association ... 51

American Association for Correctional Psychology ... 53

National Mental Health Association ... 57

National Juvenile Detention Association ... 59

Council of Juvenile Correctional Administrators ... 60

Summary and Conclusions ... 63

Annotated Bibliography ... 64

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Introduction

Suicide in custody represents a double tragedy. There is both the loss of a human life, as well as the failure by the criminal justice system to protect those whose behavior has brought them into the custody of the state. This is especially important given the large numbers of persons with mental illness who are currently incarcerated. To better understand the phenomenon of jail/custody suicide, an examination of its extent and impact is in order.

Because there is as yet no central repository of custody suicide data, the number of suicides in juvenile facilities, police lockups, county jails and state and federal prisons can only be approximated. Although the Death in Custody Reporting Act of 2000 may one day resolve this reporting problem, no data arising from this legislation are yet available for public

consumption.

We simply do not know how many juveniles kill themselves while in custody. Hayes (2000) quotes two government studies reporting 17 suicides during 1988 and 14 during 1993.

Parent et. al. (1994) reported that ten juveniles took their own lives in 1990. Memory (1989) argues that studies which find a lower suicide rate among incarcerated juveniles than free

juveniles may be methodologically flawed and that proper calculation of suicide rates by person- day exposure would reveal a suicide rate 4-5 times higher among children in custody.

Hagan identified 419 suicides in adult county jails and local police lockups during 1979 (Hayes, 1983) and argued that the suicide rate in jails was 16 times greater than in the free community. In a follow up study the inmate rate was 9 times higher (Hayes and Rowan, 1988).

This disparity between custodial suicide rates and free world rates is repeatedly cited throughout the literature (e.g. Bonner, 2000). However, O=Toole (1997) challenges such comparative

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claims because he believes suicide rates should be based on number of admissions rather than on Average Daily Population. Putting aside methodological arguments for a moment, and without examining the problem of underreporting, the Bureau of Justice Statistics reports that 324 jail inmates died by their own hand in 1999 (Stephan, 2001). During 2000, 185 state prisoners and 13 federal prisoners took their own lives (Maruschak, 2002). In a more recent discussion of jail suicide, Hayes (2003) estimates there are close to 200 prison suicides per year and between 400 and 600 jail suicides per year.

The impact of jail/custody suicide on the prisoner=s family is often exacerbated by guilt feelings as well as a resentment toward the corrections officers involved with inmate care.

Correctional officers themselves often develop a sense of guilt (Kennedy, 1994) and must sometimes face a grueling litigation process as family survivors demand accountability through the courts (Welch and Gunther, 1997; See also Raba, 1998). Naturally, in a free society such as ours, any death in police custody deserves scrutiny by appropriate authorities and the media.

While various scholars and practitioners will continue to debate methodologies, few will debate the value of prevention. It was with prevention in mind that the Jail Suicide Task Force of the American Association of Suicidology endeavored to review various operational standards designed to prevent suicide in our nation=s detention and custody facilities. National professional associations whose members are charged with prisoner and juvenile care were selected for inclusion in this review.

This effort to identify guidelines and standards is in accord with important federal policy

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objectives regarding suicide prevention in correctional settings. The National Strategy for Suicide Prevention, under Goal 8-Improve Access to and Community Linkages with Mental Health and Substance Abuse Services, lists the following objective:

Objective 8.6 -By 2005, for adult and juvenile incarcerated populations, define national guidelines for mental health screening, assessment, and treatment of suicidal individuals. Implement the guidelines in correctional institutions, jails and detention centers.

The National Strategy also identifies as an AIdea for Action@ to work with professional correctional organizations to identify and promote model suicide assessment guidelines for jails during the acute period of incarceration. It is in pursuance of the goals of the National Strategy that the AAS Jail Suicide Task Force undertakes this effort.

It must be emphasized, however, that the standards included herein do not create

constitutional requirements per Rhodes v. Chapman, 452 US 337 (1981), although they may be useful in evaluating reasonable conduct by corrections officials. Readers are urged to seek out the original materials from which the information being reported is drawn. Due to space considerations, we were forced to omit from this publication various discussions,

recommendations and definitions which the reader may find helpful.

Daniel B. Kennedy Richard McKeon

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REFERENCES

Bonner, R. (2000). Correctional suicide prevention in the year 2000 and beyond. Suicide and Life-Threatening Behavior, 30, 370-376.

Hayes. L. (2003). Scope of a national public health problem and guiding principles to prevention. Preventing Suicide, September, 2-5.

Hayes. L. (2000). Suicide prevention in juvenile facilities. Juvenile Justice, 7, 24-32.

Hayes, L. and Rowan, J. (1988). National study of jail suicides: seven years later. Alexandria, VA: National Center for Institutions and Alternatives.

Kennedy, D. (1994). Custodial suicide: Rethinking the problem. American Jails, January/February, 41-45.

Maruschak, L. (2002). HIV in Prisons, 2000. Washington, D.C.: U.S. Department of Justice.

Memory, J. (1989). Juvenile suicides in secure detention facilities: Correction of published rates. Death Studies, 13, 455-463.

O=Toole, M. (1997). Jails and prisoners: The numbers say they are more different than generally assumed. American Jails, May/June, 27-31.

Parent, D., Lieter, V., Kennedy, S., Livers, L., Wentworth, D., and Wilcox, S. (1994).

Conditions of Confinement: Juvenile Detention and Corrections Facilities. Washington, D.C.: U.S. Department of Justice.

Raba, J. (1998). Mortality in prisons and jails. In M. Puisis (Ed.). Clinical Practice in Correctional Medicine, (pp. 301-313). St. Louis: Mosby, Inc.

Stephan, J. (2001). Census of Jails, 1999. Washington, D.C.; U.S. Department of Justice.

Welch, M. and Gunther, D. (1997). Jail suicide under legal scrutiny: An analysis of litigation and its implications to policy. Criminal Justice Policy Review, 8, 75-97.

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American Correctional Association

4380 Forbes Boulevard Lanham, MD 20706-4322

(800) 222-5646 www.aca.org

For more than 125 years, the American Correctional Association (ACA) has championed the cause of corrections and correctional effectiveness. Founded in 1870 as the National Prison Association, ACA is the oldest association developed specifically for practitioners in the correctional profession. At the 1954 Congress of Correction in Philadelphia, Pennsylvania, the name of the American Prison Association was changed to the American Correctional

Association, reflecting the expanding philosophy of corrections and its increasingly important role within the community and society as a whole. Today, the ACA has more than 20,000 active members.

The ACA publishes its recommended standards in book form. These standards pertain to 20 different programs, services and facilities. Just five sets of standards were selected for this review, including Standards for Adult local Detention Facilities (1999), Standards for Small Jail Facilities (1989), Performance-Based Standards for Correctional Health Care in Adult

Correctional Institutions (2002), Standards for Juvenile Training Schools (1991), and Standards for Juvenile Detention Facilities (1991). Each standards book is updated periodically, most recently by the 2002 Standards Supplement (2002).

Listed below are the standards most pertinent to suicide prevention in each of five types of correctional facilities.

Adult Local Detention Facilities (Jails)

Training Requirements

3-ALDF Revised January 1994. Written policy, procedure, and practice provide that all ID-12 new correctional officers receive an added 120 hours of training during their

first year of employment, and an added 40 hours of training each subsequent year of employment. At a minimum this training covers the following areas:

$ security procedures

$ supervision of offenders

$ signs of suicide risks

$ suicide precautions

$ use-of-force regulations and tactics

$ report writing

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$ offender rules and regulations

$ rights and responsibilities of offenders

$ fire and emergency procedures

$ safety procedures

$ key control

$ interpersonal relations

$ social/cultural lifestyles of the offender population

$ communication skills

$ first aid/CPR

$ counseling techniques

$ cultural diversity Supervision

3-ALDF Written policy, procedure, and practice require that all special management 3D-08 inmates are personally observed by a correctional officer at least every 30

(Ref. New) minutes on an irregular schedule. Inmates who are violent or mentally disordered or who demonstrate unusual or bizarre behavior receive more frequent

observation; suicidal inmates are under continuous observation.

Reception and Orientation

3-ALDF Written policies and procedures govern the admission of inmates new to the 4A-01 system. These procedures include at a minimum the following:

(Ref. 2-5346)

$ determination that inmate is legally committed to the facility

$ drug/alcohol use

$ thorough search of the individual and possessions

$ disposition of personal property

$ shower and hair care, if necessary

$ issue of clean, laundered clothing when appropriate

$ photographing and fingerprinting, including notation or identifying marks or other unusual physical characteristics

$ medical, dental, and mental health screening

$ assignment to housing unit

$ recording basic personal data and information to be used for mail and visiting list

$ explanation of mail and visiting procedures

$ assistance to inmates in notifying their next of kin and families of admission

$ suicide screening

$ assignment of registered number to the inmate

$ giving written orientation materials to the inmate

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$ telephone calls by inmate

$ assignment of a housing unit

$ criminal history check Special Management Inmates

3-ALDF The facility provides for the separate management of the following categories of 4B-03 inmates:

(Ref. 2-5354)

$ female and male inmates

$ other classes of detainees (witnesses, civil inmates)

$ community custody inmates (work releases, weekender, trustees)

$ inmates with special problems (alcoholics, narcotics addicts, mentally disturbed persons, physically handicapped persons, persons with

communicable diseases)

$ inmates requiring disciplinary detention

$ inmates requiring administrative segregation

$ juveniles

Suicide Prevention and Intervention

3-ALDF Revised August 1994 (MANDATORY). There is a written suicide prevention 4E-34 and intervention program that is reviewed and approved by a qualified medical or

mental health professional. All staff with responsibility for inmate supervision are trained in the implementation of the program.

Small Jail Facilities (<50 Inmates)

Training and Staff Development

SJ-028 Revised October 1997. Written policy, procedure, and practice provide that all new correctional officers receive an added 120 hours of training during their first year of employment and an added 40 hours of training each subsequent year of employment. At a minimum, this training covers the following areas:

$ supervision of offenders

$ signs of suicide risk

$ report writing

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$ offender rules and regulations

$ rights and responsibilities of offenders

$ safety procedures

$ key control

$ social/cultural lifestyles of the offender population

$ first aid/CPR

$ cultural diversity Physical Plant

SJ-051 Revised October 1997. Written policy, procedure, and practice provide that single-occupancy cells/rooms shall be available when indicated for the following:

$ inmates with severe medical disabilities

$ inmates suffering from serious mental illness

$ sexual predators

$ inmates likely to be exploited or victimized by others

$ inmates who have other special needs for single-occupancy housing Security and Control

SJ-086 Written policy and procedure require that all high and medium security inmates are personally observed by a correctional officer at least every thirty minutes, but on an irregular schedule. More frequent observation is required for those inmates who are mentally disordered or who demonstrate unusual or bizarre behavior.

Suicidal inmates are under continuous observation.

Health Care Services

SJ-147 Written policy and procedure require medical screening to be performed by health-trained staff on all inmates on arrival at the facility. The findings are recorded on a printed screening form approved by the health authority. The screening process includes at least the following procedures:

1. Inquiry into

$ current illness and health problems, including dental problems, sexually transmitted diseases and other infectious disease

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$ medication taken and special health requirements

$ use of alcohol and other drugs, which includes types of drugs used, mode of use, amounts used, frequency used, date or time of last use

and history of problems that may have occurred after ceasing use (e.g., convulsions)

$ past and present treatment or hospitalization for mental disturbance or suicide

$ other health problems designated by the responsible physician

$ mental illness 2. Observations of

$ behavior, which includes state of consciousness, mental status, appearance, conduct, tremor and sweating

$ body deformities, trauma markings, bruises, lesions, jaundice, ease of movement, etc.

3. Disposition to

(MANDATORY)

$ general population

$ general population and referral to appropriate health care service

$ referral to appropriate health care service on an emergency basis

Classification

SJ-191 Written policy, procedure, and practice provide for inmate classification in terms of level of custody required, housing assignment, and participation in

correctional programs. They are reviewed at least annually and updated if necessary. These include, at a minimum:

1. Criteria and procedures for determining and changing the status of an inmate, including custody, transfers, and major changes in programs

2 An appeals process for classification decisions

3. The separate management of the following categories of inmates:

$ female and male inmates

$ other classes of detainees (witnesses, civil prisoners)

$ community custody inmates (work releases, weekenders, trusties)

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$ inmates with special problems (alcoholics, narcotics addicts, mentally disturbed, physically handicapped, those with communicable diseases)

$ inmates requiring disciplinary detention

$ inmates requiring administrative segregation

$ juveniles

Adult Correctional Facilities (Prisons)

Mental Health Program

1-HC-1A-25 (MANDATORY) There is a mental health program that includes at a minimum:

(Ref. 3-4336)

$ screening for mental health problems on intake as approved by the mental health professional

$ outpatient services for the detection, diagnosis, and treatment of mental illness

$ crisis intervention and the management of acute psychiatric episodes

$ stabilization of the mentally ill and the prevention of psychiatric deterioration in the correctional setting

$ elective therapy services and preventive treatment where resources permit

$ provision for referral and admission to licensed mental health facilities for offenders whose psychiatric needs exceed the treatment capability of the facility

$ procedures for obtaining and documenting informed consent Mental Health Screen

1-HC-1A-27 (MANDATORY) All intersystem and intrasystem transfer offenders will (Ref. New) receive an initial mental health screening at the time of admission to the facility

by mental health trained or qualified mental health care personnel. The mental health screening includes, but is not limited to:

Inquiry into:

$ whether the offender has a present suicide ideation

$ whether the offender has a history of suicidal behavior

$ whether the offender is presently prescribed psychotropic medication

$ whether the offender has a current mental health complaint

$ whether the offenders are being treated for mental health problems

$ whether the offender has a history of inpatient and outpatient psychiatric treatment

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$ whether the offender has a history of treatment for substance abuse Observation of:

$ general appearance and behavior

$ evidence of abuse and or trauma

$ current symptoms of psychosis, depression, anxiety, and or aggression

Disposition of offender:

$ to the general population

$ to the general population with appropriate referral to mental health care service

$ referral to appropriate mental health care service for emergency treatment Mental Health Appraisal

1-HC-1A-28 (MANDATORY) All intersystem offender transfers will undergo a mental

(Ref. New) appraisal by a qualified health person within fourteen days of admission to a facility. If there is documented evidence of a mental health appraisal within the previous ninety days, a new mental health appraisal is not required, except as determined by the designated mental health authority. Mental health examinations include, but are not limited to:

$ assessment of current mental status and condition

$ assessment of current suicidal potential and person-specific circumstances that increase suicide potential

$ assessment of violence potential and person-specific circumstances that increase violence potential

$ review of available historical records of inpatient and outpatient psychiatric treatment

$ review of history of treatment with psychotropic medication

$ review of history of psychotherapy, psycho educational groups, and classes or support groups

$ review of history of drug and alcohol treatment

$ review of educational history

$ review of history of sexual abuse-victimization and predatory behavior

$ assessment of drug and alcohol abuse and/or addiction

$ use of additional assessment tools, as indicated

$ referral to treatment, as indicated

$ development and implementation of a treatment plan, including

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recommendations concerning housing, job assignment, and program participation

1-HC-1A-30 (MANDATORY) There is a written suicide prevention plan that is approved by

(Ref 3-4364) the health authority and reviewed by the facility or program administrator. The plan includes staff and offender critical incident debriefing that covers the

management of suicidal incidents, suicide watch, and death of an offender or staff member. It ensures a review of critical incidents by administration, security, and health services. All staff with responsibility for offender supervision are trained

on an annual basis in the implementation of the program. Training should include but not be limited to:

$ identifying the warning signs and symptoms of impending suicidal behavior

$ understanding the demographic and cultural parameters of suicidal behavior, including incidence and variations in precipitating factors responding to

suicidal and depressed offenders

$ communication between correctional and health care personnel referral procedures

$ housing observation and suicide watch level procedures

$ follow-up monitoring of offenders who make a suicide attempt Emergency Response

1-HC-2A-14 (MANDATORY) Correctional and health care personnel are trained to respond

(Ref. 3-4351) to health related situations within a four-minute response time. The training program is conducted on an annual basis and is established by the responsible health authority in cooperation with the facility or program administrator and includes instruction on the following:

$ recognition of signs and symptoms, and knowledge of action that is required in potential emergency situations

$ administration of basic first aid

$ certification in cardiopulmonary resuscitation (CPR) in accordance with the recommendations of the certifying health organization

$ methods of obtaining assistance

$ signs and symptoms of mental illness, violent behavior, and acute chemical intoxication and withdrawal

$ procedures for patient transfers to appropriate medical facilities or health care providers

$ suicide intervention

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Offender Assistants

1-HC-2A-18 Unless prohibited by state law, offenders (under staff supervision) may

(Ref. 34340) perform familial duties commensurate with their level of training. These duties may include the following:

$ peer support and education

$ hospice activities

$ assisting impaired offenders on a one-on-one basis with activities of daily living

$ serving as a suicide companion or buddy if qualified and trained through a formal program that is part of a suicide prevention plan Offenders are not to be used for the following duties:

$ performing direct patient care services

$ scheduling health care appointments

$ determining access of other offenders to health care services

$ handling or having access to surgical instruments, syringes, needles, medications, or health records

$ operating diagnostic or therapeutic equipment except under direct supervision (by specially trained staff) in a vocational training program

Internal Review and Quality Assurance

1-HC-4A-03 (MANDATORY) A system of documented internal review will be developed and

(Ref. New) implemented by the health authority. The necessary elements of the system will include:

$ participating in a multidisciplinary quality improvement committee

$ collecting, trending, and analyzing data combined with planning, intervening, and reassessing

$ evaluating defined data, which will result in more effective access, improved quality of care, and better utilization of resources

$ on-site monitoring of health service outcomes on a regular basis through:

a. chart reviews by the responsible physician or his or her designee, including investigation of complaints and quality of health records b. review of prescribing practices and administration of medication

practices

c. systematic investigation of complaints and grievances d. monitoring of corrective action plans

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$ reviewing all deaths in custody, suicides or suicide attempts, and illness outbreaks

$ implementing measures to address and resolve important problems and concerns identified (corrective action plans)

$ reevaluating problems or concerns to determine objectively whether the corrective measures have achieved and sustained the desired results

$ incorporating findings of internal review activities into the organization=s educational and training activities

$ maintaining appropriate records (for example, meeting minutes) of internal review activities

$ issuing a quarterly report to be provided to the health services administrator and facility or program administrator of the findings of internal review activities

$ requiring a provision that records of internal review activities comply with legal requirements on confidentiality of records

Clothing

1-HC-5A-04 When standard issued clothing presents a security or medical risk (for

(Ref. New) example, suicide observation), provisions are made to supply the offender with a security garment that will promote offender safety in a way that is designed to prevent humiliation and degradation.

Juvenile Training Schools

Admissions and Review

3-JTS-3E-01 Written policy, procedure, and practice provide special management for

(Ref. 2-9189) juveniles with serious behavior problems and for juveniles requiring protective care. An individual program plan will be developed.

3-JTS-3E-04 Juveniles placed in confinement are checked visually by staff at least every 15

(Ref. 2-9302) minutes and are visited at least once each day by personnel from administrative, clinical, social work, religious, or medical units. A log is kept recording who authorized the confinement, persons visiting the juvenile, the person authorizing release from confinement, and the time of release.

Mental Health Services

3-JTS-4C-16 Written policy, procedure, and practice specify the provision of mental health

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(Ref. New) services for juveniles. These services include but are not limited to those provided by qualified mental health professionals who meet the educational license/certification criteria specified by their respective professional discipline (e.g., psychiatric nursing, psychiatry, psychology, and social work).

Health Screenings and Examinations

3-JTS-4C-22 Written policy, procedure, and practice require medical, dental and mental (Ref. 2- 9245) health screening to be performed by health-trained or qualified health care Mandatory personnel on all juveniles, excluding intrasystem transfers on juveniles' arrival at

the facility. All findings are recorded on a form approved by the health authority. The screening form includes at least the following:

Inquiry into:

$ current illness and health problems, including venereal diseases and other infectious diseases

$ dental problems

$ mental health problems

$ use of alcohol and other drugs, which includes types of drugs used, mode of use, amounts used, frequency used, date or time of last use, and a history of problems that may have occurred after ceasing use (e.g., convulsions)

$ other health problems designated by the responsible physician Observation of:

$ behavior, which includes state of consciousness, mental status, appearance, conduct, tremor, and sweating

$ body deformities, ease of movement, etc.

$ condition of skin, including trauma markings, bruises, lesions, jaundice, rashes and infestations, and needle marks or other indications of drug abuse.

Medical disposition of juvenile:

$ general population OR

$ general population with appropriate referral to health care service OR

$ referral to appropriate health care service for emergency treatment Comprehensive Education Program

3-JTS-5D-02 The facility provides or makes available to all juveniles the following program

(Ref.2-9334) and services, at a minimum:

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$ reception and orientation

$ evaluation and classification

$ educational programs that will include opportunity for vocational/job training

$ religious services and/or counseling

$ social services

$ psychological and psychiatric services, if needed

$ library services

$ medical and dental health care

$ athletic, recreational, and leisure-time activities

$ juvenile involvement with community groups

$ mail and visiting privileges

$ access to media, legal material, attorneys, and courts

$ prerelease orientation and planning

Juvenile Detention Facilities

3-JDF-ID-09 Revised January 1994. Written policy, procedure, and practice provide that all new juvenile care workers receive an added 120 hours of training during their first year of employment and an added 40 hours of training each subsequent year of employment. At a minimum this training covers the following areas:

$ supervision of juveniles

$ report writing

$ juvenile rules and regulations

$ rights and responsibilities of juveniles

$ safety procedures

$ key control

$ social/cultural lifestyles of the juvenile population

$ first aid/CPR

$ cultural diversity Specialist Employees

3-JDF-lD-10 Written policy, procedure, and practice provide that all professional specialist

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(Ref. 2-8092) employees who have juvenile contact receive an additional 120 hours of training during their first year of employment and an additional 40 hours of training each subsequent year of employment. At a minimum this training covers the following areas:

$ supervision of juveniles

$ report writing

$ juvenile rules and regulations

$ rights and responsibilities of juveniles

$ key control

$ social/cultural lifestyles of the juvenile population

$ first aid

$ counseling techniques Protection From Harm

3-JDF-3D-06 Written Policy, procedure, and practice protect juveniles from personal

(Ref. 2-8301) abuse, corporal punishment, personal injury, disease, property damage, and harassment.

Admission and Review

3-JDF-3E-04 Juveniles placed in confinement are checked visually by staff at least every 15

(Ref. 2-8321) minutes and are visited at least once each day by personnel from administrative, clinical, social work, religious, or medical units. A log is kept recording who authorized the confinement, persons visiting the juvenile, the person authorizing release from confinement, and the time of release.

Health Screenings and Examinations

3-JDF-4C-21 Written policy, procedure and practice require medical, dental, and mental (Ref. 2-8264) health screening to be performed by health-trained or qualified health care Mandatory personnel on all juveniles, excluding intrasystem transfers, on arrival at the

facility. All findings are recorded on a form approved by the health authority. The screening form includes at least the following:

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Inquiry into:

$ current illness and health problems, including venereal diseases and other infectious diseases

$ dental problems

$ mental health problems

$ use of alcohol and other drugs, which includes types of drugs used, mode of use, amounts used, frequency of use, date or time of last use, and a history of problems that may have occurred after ceasing use (e.g., convulsions)

$ other health problems designated by the responsible physician Observation of:

$ behavior, which includes state of consciousness, mental status, appearance, conduct, tremor, and sweating

$ body deformities, ease of movement, etc.

$ condition of skin, including trauma markings, bruises, lesions, jaundice, rashes and infestations, and needle marks or other indications of drug abuse Medical disposition of juvenile:

$ general population OR

$ general population with appropriate referral to health care service OR

$ referral to appropriate health care service for emergency treatment First Aid

3-JDF-4C-27 Written policy, procedure, and practice provide that juvenile care worker staff

(Ref. 2-8273) and other personnel are trained to respond to health-related situations within a Mandatory four-minute response time. A training program is established by the responsible

health authority in cooperation with the facility administrator that includes the following:

$ recognition of signs and symptoms and knowledge of action required in potential emergency situations

$ administration of first aid and cardiopulmonary resuscitation (CPR)

$ methods of obtaining assistance

$ signs and symptoms of mental illness, retardation, and chemical dependency

$ procedures for patient transfers to appropriate medical facilities or health care providers

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3-JDF 4C-35 There is a written suicide prevention and intervention program that is reviewed Revised and approved by a qualified medical or mental health professional. All staff August 1994 with responsibility for juvenile supervision are trained in the implementation (Mandatory) of the program.

Intake

3-JDF-5A-02 Written procedures for admission of juveniles new to the system include but are (Ref. 2-8349, not limited to the following:

2-8350)

$ determination that the juvenile is legally committed to the facility

$ complete search of the juvenile and possessions

$ disposition of personal property

$ shower and hair care, if necessary

$ issue of clean, laundered clothing, as needed issue of personal hygiene articles

$ medical, dental, and mental health screening

$ assignment to a housing unit

$ recording of basic personal data and information to be used for mail and visiting lists

$ assistance to juveniles in notifying their families of their admission and procedures for mail and visiting

$ assignment of a registered number to the juvenile

$ provision of written orientation materials to the juvenile

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National Commission on Correctional Health Care

1300 W. Belmont Avenue P.O. Box 11117 Chicago, Illinois 60611

(773) 880-1460 www.ncchc.org

The National Commission on Correctional Health Care (NCCHC) origins date to the early 1970's, when an American Medical Association study of jails found inadequate,

disorganized health services and a lack of national standards to guide correctional institutions.

In collaboration with other organizations, the AMA established a program that in the early 1980's became the National Commission on Correctional Health Care, an independent, not-for- profit 501(c)(3) organization. NCCHC's early mission was to evaluate formulate policy and develop programs for an area clearly in need of assistance. Today, NCCHC's leadership in setting standards for health services and improving health care in correctional facilities is widely recognized.

Standards for Health Services in Jail

J-A-08 Communication on Special Needs Patients essential

Standard

Communication occurs between the facility administration and treating clinicians regarding inmates' significant health needs that must be considered in

classification decisions in order to preserve the health and safety of that inmate, other inmates, or staff.

Compliance Indicators

1. All aspects of the standard are addressed by written policy and defined procedures.

2. Correctional staff are advised of inmates' special needs that may affect housing, work, and program assignments; disciplinary measures; and admissions to and transfers from institutions. Such communication is documented.

3 . Health and custody staff communicate about inmates who are:

a. chronically ill b. on dialysis;

c. adolescents in adult facilities;

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d. infected with serious communicable diseases;

e. physically disabled;

f. pregnant;

g. frail or elderly;

h. terminally ill;

i. mentally ill or suicidal; or j. developmentally disabled.

J-C-04 Training for Correctional Officers essential

Standard

A training program, established or approved by the responsible health authority in cooperation with the facility administrator, guides the health-related training of all correctional officers who work with inmates.

2. Correctional officers who work with inmates receive health-related training at least every 2 years, which includes at a minimum:

a. administration of first aid;

b. recognizing the need for emergency care and intervention in life- threatening situations (e.g., heart attack);

c. recognizing acute manifestations of certain chronic illnesses (e.g., asthma, seizures), intoxication and withdrawal, and adverse reactions to

medications;

d. recognizing signs and symptoms of mental illness;

e. procedures for suicide prevention;

f. procedures for appropriate referral of inmates with health complaints to health staff;

g. precautions and procedures with respect to infectious and communicable diseases; and

h. cardiopulmonary resuscitation.

3. The appropriateness of the health-related training is verified by an outline of the course content and the length of the course.

4. A certificate or other evidence of attendance is kept on site for each employee.

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5. While it is expected that 100% of the correctional staff who work with

inmates are trained in all of these areas, compliance with the standard requires that at least 75% of the staff present on each shift are current in their health- related training.

J-E-02 Receiving Screening essential

Standard

Receiving screening is performed on all inmates immediately upon arrival at the intake facility.

2. Qualified health care professionals or health-trained personnel perform the receiving screening.

3. The receiving screening takes place immediately for all inmates.

4. Persons who are unconscious, semiconscious, bleeding, mentally unstable, or otherwise urgently in need of medical attention are referred immediately for care. If inmates are referred to a community hospital and are returned, their admission to the facility is predicated upon written medical clearance.

5. Reception personnel, using a health-authority-approved form, inquire about:

a. current and past illnesses, health conditions, or special health requirements (e.g., dietary needs);

b. past serious infectious disease;

c. recent communicable illness symptoms (e.g., chronic cough, coughing up blood, lethargy, weakness, weight loss, loss of appetite, fever, night sweats);

d. past or current mental illness, including hospitalizations;

e. history of or current suicidal ideation;

f. dental problems;

g. allergies;

h. legal and illegal drug use (including the time of last use);

i drug withdrawal symptoms;

j. current or recent pregnancy; and

k. other health problems as designated by the responsible physician.

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6. Reception personnel record, on the receiving screening form, an observation of the inmate's:

a. appearance (e.g., sweating, tremors, anxious, disheveled);

b. behavior (e.g., disorderly, appropriate, insensible);

c. state of consciousness (e.g., alert, responsive, lethargic);

d. ease of movement (e.g., body deformities, gait);

e. breathing (e.g., persistent cough, hyperventilation); and

f. skin (including lesions, jaundice, rashes, infestations, bruises, scars, tattoos, and needle marks or other indications of drug abuse).

7. When clinically indicated, there is an immediate referral to an appropriate health care service. The referral is noted on the receiving screening form.

8. The disposition of the inmate (e.g., immediate referral to an appropriate health care service, placed in general inmate population) is indicated on the receiving screening form.

9. Receiving screening forms are dated and timed immediately upon completion and include the signature and title of the person completing the receiving screening form.

10. Immediate health needs are identified and addressed, and potentially infectious inmates are isolated.

J-E-05 Mental Health Screening and Evaluation essential

Standard

All inmates receive mental health screening; inmates with positive screens receive a mental health evaluation.

1. There is a written policy and defined procedures addressing the postadmission mental health screening and evaluation process.

2. Within 14 days of admission to the correctional system, qualified mental health professionals or mental health staff conduct initial mental health screening.

3. The initial mental health screening includes a structured interview with inquiries into:

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a. a history of:

1. psychiatric hospitalization and outpatient treatment, 2. suicidal behavior,

3. violent behavior, 4. victimization,

5. special education placement, 6. cerebral trauma or seizures, and 7. sex offenses;

b. the current status of:

1. psychotropic medications, 2. suicidal ideation,

3. drug or alcohol use, and

4. orientation to person, place, and time;

c. emotional response to incarceration; and

d. a screening for intellectual functioning (i.e., mental retardation, developmental disability, learning disability).

4. The patient's health record contains results of the initial screening.

5. Inmates with positive screening for mental health problems are referred to qualified mental health professionals for further evaluation.

6. The health record contains results of the evaluation with documentation of referral or initiation of treatment when indicated.

7. Patients who require acute mental health services beyond those available at the facility are transferred to an appropriate facility.

J-G-01 Special Needs Treatment Plans essential

Standard

A proactive program exists that provides care for special needs patients who require close medical supervision or multidisciplinary care.

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2. Individual treatment plans are developed by a physician or other qualified clinician at the time the condition is identified, and updated when warranted.

3. The treatment plan includes, at a minimum:

a. the frequency of follow-up for medical evaluation and adjustment of treatment modality;

b. the type and frequency of diagnostic testing and therapeutic regimens; and c. when appropriate, instructions about diet, exercise, adaptation to the

correctional environment, and medication.

4. Special needs are listed on the master problem list.

5. The facility maintains a list of special needs patients.

J-G-04 Mental Health Services

essential

Standard

Mental health services are available for all inmates who require them.

2. Treatment services minimally include on or off-site crisis intervention including short-term individual and/or group therapy follow-up, as needed, and psychotropic medication management.

3. Mental health, medical, and substance abuse services are sufficiently

coordinated such that patient management is appropriately integrated, health needs are met, and the impact of any of these conditions on each other is adequately addressed.

J-G-05 Suicide Prevention Program essential

Standard

The facility has a program that identifies and responds to suicidal inmates.

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2. The suicide prevention program includes the following:

a. training, b. identification, c. referral, d. evaluation, e. housing, f. monitoring, g. communication, h. intervention, i. notification, j. reporting, k. review, and

l. critical incident debriefing.

3. When a facility employs other inmates in any way in the suicide prevention program (e.g., companions, suicide-prevention aides), the inmate's role is supplemental to and does not take the place of staff supervision.

Discussion

While juveniles may become suicidal at any point during their stay, high-risk periods include the time immediately upon admission to the facility; after adjudication, when the juvenile is returned to a facility from court; following the receipt of bad news regarding self or family (e.g., serious illness, the loss of a loved one); prolonged stays in juvenile detention facilities; and after suffering some type of humiliation or

rejection (e.g., sexual assault). Juveniles entering and/or unable to cope with

segregation or other specialized single-cell housing assignments are also at increased risk of suicide. In addition, juveniles who are in the early stages of recovery from severe depression may be at risk as well.

Key components of a suicide prevention program include the following:

1. Training. All staff who work with juveniles should be trained to recognize verbal and behavioral cues and to watch for signs of vulnerability that indicate potential suicide, and how to respond appropriately. The plan should include initial and subsequent training.

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2. Identification. The receiving screening form should include observation and interview items related to each juvenile's potential suicide risk (see the sample screening forms in Appendix B).

3. Monitoring. The plan should specify the facility's procedures for monitoring a juvenile who has been identified as potentially suicidal. Regular, documented supervision should be maintained. Other supervision aids (e.g., closed circuit television, juvenile companions/watchers) can be utilized as a supplement to, but never as a substitute for, staff supervision. (See Appendix F for sample protocols on suicide precaution levels.)

4. Referral. The plan should specify the procedures for referring potentially suicidal juveniles and attempted suicides to mental health care providers or facilities. The plan also should specify a time frame for response to the referral.

5. Evaluation. This should be conducted by a qualified mental health

professional, who designates the juvenile's level of suicide risk (see Appendix F). The purpose of the evaluation is to determine the juvenile's suicide risk, the need for hospitalization, or the need for transfer to an inpatient health facility. Patients should be reassessed periodically to identify any change in condition.

6. Housing. An actively suicidal juvenile always should be observed on a continuous, uninterrupted basis, or transferred to an appropriate facility. A potentially suicidal juvenile should not be housed or left alone unless constant supervision can be maintained. If a sufficiently large staff is not available so that constant supervision can be provided when needed, the juvenile should not be isolated. Rather, she/he should be housed with another resident and checked every 10 15 minutes. The room should be as suicide-resistant as possible (i.e., without protrusions of any kind that would enable the juvenile to hang him/herself). It is inappropriate to place a suicidal youth in a

maximum security isolation unit.

7. Communication. Procedures for communication between health services staff and child care workers regarding the status of the juvenile should exist to provide clear and current information. These procedures also should include communication between transferring authorities (e.g., court personnel, medical/psychiatric facility) and child care workers.

8. Intervention. The plan should address how to handle a suicide in progress, including appropriate first-aid measures.

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9. Notification. Procedures should be in place stating when facility

administrators, outside authorities, and legal guardians should be notified of potential, attempted, and completed suicides.

10. Reporting. Procedures for documenting the identification and monitoring of potential or attempted suicides should be detailed, as should procedures for reporting a completed suicide. The facility administrators and the health authority should receive reports about attempted and completed suicides.

11. Review. The plan should specify a medical and administrative review process if a suicide or serious attempt does occur.

12. Critical incident stress debriefing (CISD). Responding to and/or observing a suicide in progress can be extremely stressful for staff and juveniles. The plan should specify the procedures for offering CISD to all affected personnel and juveniles.

Standards for Health Services in Prisons

P-A-08 Communication on Special Needs Patients essential

Standard

Communication occurs between the facility administration and treating clinicians regarding inmates' significant health needs that must be considered in

classification decisions in order to preserve the health and safety of that inmate, other inmates, or staff.

2. Correctional staff are advised of inmates' special needs that may affect housing, work, and program assignments; disciplinary measures; and admissions to and transfers from institutions. Such communication is documented.

3 . Health and custody staff communicate about inmates who are:

a. chronically ill;

b. on dialysis;

c. adolescents in adult facilities;

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d. infected with serious communicable diseases;

e. physically disabled;

f. pregnant;

g. frail or elderly;

h. terminally ill;

i. mentally ill or suicidal; or j. developmentally disabled.

P-C-04 Training for Correctional Officers essential

Standard

A training program, established or approved by the responsible health authority in cooperation with the facility administrator, guides the health-related training of all correctional officers who work with inmates.

2. Correctional officers who work with inmates receive health-related training at least every 2 years, which includes at a minimum:

a. administration of first aid;

b. recognizing the need for emergency care and intervention in life- threatening situations (e.g., heart attack);

c. recognizing acute manifestations of certain chronic illnesses (e.g., asthma, seizures), intoxication and withdrawal, and adverse reactions to

medications;

d. recognizing signs and symptoms of mental illness;

e. procedures for suicide prevention;

f. procedures for appropriate referral of inmates with health complaints to health staff;

g. precautions and procedures with respect to infectious and communicable diseases; and

h. cardiopulmonary resuscitation.

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3. The appropriateness of the health-related training is verified by an outline of the course content and the length of the course.

4. A certificate or other evidence of attendance is kept on site for each employee.

5. While it is expected that 100% of the correctional staff who work with

inmates are trained in all of these areas, compliance with the standard requires that at least 75% of the staff present on each shift are current in their health- related training.

P-E-02 Receiving Screening essential

Standard

Receiving screening is performed on all inmates immediately upon arrival at the intake facility.

2. Qualified health care professionals perform the receiving screening. In facilities with fewer than 500 inmates, health-trained correctional personnel may perform this function.

3. The receiving screening takes place immediately for all inmates.

4. Persons who are unconscious, semiconscious, bleeding, mentally unstable, or otherwise urgently in need of medical attention are referred immediately for care. If inmates are referred to a community hospital and are returned, their admission to the facility is predicated upon written medical clearance.

5. Reception personnel, using a health-authority-approved form, inquire about:

a. current and past illnesses, health conditions, or special health requirements (e.g., dietary needs);

b. past serious infectious disease;